<html>
    <head>
        <title>Formulir Data Kartu Keluarga</title>
        <link href="<?php echo base_url('assets/css/formkk.css'); ?>" rel="stylesheet" type="text/css">
    </head>

    <body>
        <form action="<?php echo base_url('kk/tambah'); ?>" method="post" enctype="multipart/form-data">
      <table width="672" border="0" align="center">
                <tr>
                    <td colspan="5" class="trheader"><strong>Formulir Data Kartu Keluarga</strong></td>
                </tr>
                <tr>
                    <td width="140">No. KK</td>
                    <td colspan="4"><input type="text" name="kk" id="kk" class="textinput" placeholder="3501062001053536"/></td>
                </tr>
                <tr>
                    <td width="140">NIK Kepala Keluarga</td>
                    <td colspan="4"><input type="text" name="nik" id="nik" class="textinput" placeholder="350106120119640002"/>
                        <input type="button" name="lihatpenduduk" id="lihatpenduduk" value="Cari Data Penduduk" class="radiobutton-kiri" /></td>
                </tr>
                <tr>
                    <td>Alamat</td>
                    <td colspan="2"><input type="text" name="alamat" id="alamat" class="textinput" placeholder="Tleken" /></td>
                    <td colspan="3">
                        RT<input type="text" name="rt" id="rt" class="textinputdua" placeholder="01" />
                        RW<input type="text" name="rw" id="rw" class="textinputdua" placeholder="X" /></td>
                </tr>
                <tr>
                    <td>Status KK</td>
                    <td colspan="4"><label>
                            <select name="status_kk" id="status_kk" class="list">
                                <option value="1">Numpang KK</option>
                                <option value="2" selected>Membuat KK Baru</option>
                                <option value="3">Nomor KK Tetap</option>
                            </select>
                        </label></td>
                </tr>
                <tr>
                    <td>Tanggal Pembuatan</td>
                    <td colspan="4"><input type="text" name="tgl_buat" id="tgl_buat" class="textinputdua" placeholder="TANGGAL" /></td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td width="107">&nbsp;</td>
                    <td width="105">&nbsp;</td>
                    <td width="48">&nbsp;</td>
                    <td width="250">&nbsp;</td>
                </tr>
                <tr>
                    <td colspan="3"><input type="submit" name="tambah" id="tambah" value="Tambah" class="radiobutton-kiri"/>
                        <input type="submit" name="ubah" id="ubah" value="Ubah" class="radiobutton-kiri" /></td>
                    <td><input type="submit" name="lihat" id="lihat" value="Lihat Data" class="radiobutton-kiri" /></td>
                    <td>&nbsp;</td>
                </tr>
            </table>



        </form>
</body>
</html>
